Inhalers spacers

Geriatric Considerations - Summary Ensure that the older adult can adequately use the inhalation device. A spacer maybe beneficial in fhose unable fo coordinate device operation and inhalation. Spacer devices improve drug delivery to the lungs, therefore monitor closely as the patient may also experience increased systemic side effects with improved exposure to albuterol. Monitor cardiac status. 

R. Ahrens, C. Lux, T. Bahl, and S. H. Han, Choosing the metered-dose inhaler spacer or holding chamber that matches the patient s need evidence that the specific drug being delivered is an important consideration, J. Allergy Clin. Immunol. 96 288 (1995). 

Hanania NA, Wittman R, Kesten S, Chapman KR. Medical personnel s knowledge of and ability to use inhaling devices metered dose inhalers, spacer chambers, and breath actuated dry powder inhalers. Chest 1994 105 111-116. 

To properly instruct the patient in administration of drug via a metered-dose inhaler, the nurse must be aware of general instructions for use for all metered-dose inhalers and three common methods of rise holding the lips around the mouthpiece, holding the inhaler away from the mouth, and rising a spacer or extender. 

Holding the Inhaler A way From the Mouth. This method involves the use of a device called an extender or spacer attached to the inhaler. Use of the extender allows more drug to reach the lung. The nurse teaches the patient to ... 

Drug dispersion using a metered dose-inhaler with and without a spacer. (Adapted from the American Lung Assoaation. [1993], Understanding lung medications How they work—how to use them, p. 5)... 

A metered dose inhaler with spacer is equivalent to nebulized therapy, may have a more rapid onset, and fewer adverse effects ° 4-8 puff doses... 

Short-acting inhaled p2-agonist by nebulizer or facemask and spacer/holding chamber... 

Because all inhaled corticosteroids are equally effective if given in equipotent doses, product selection should be individualized based on the available dosage form, delivery device, and patient preference. In infants, administration may require the use of a nebulizer or spacer/holding chamber with a facemask. Caregivers should use a soft, damp cloth to wipe the face of infants receiving an inhaled corticosteroid via a facemask to prevent topical candidiasis.18... 

MDI 90 mcg/puff 4-8 puffs every 20 minutes up to 4 hours, then every 1-4 hours as needed 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours inhalation maneuver use spacer/holding chamber... 

Assess whether or not the patient can use an MDI with a spacer or holding chamber. If the patient cannot use the device, determine whether someone can assist the patient with the inhaler device, or whether a nebulizer is necessary. 

The most common adverse effects from inhaled corticosteroids include oropharyngeal candidiasis and hoarse voice. These can be minimized by rinsing the mouth after use and by using a spacer device with metered-dose inhalers. Increased bruising and decreased bone density have also been reported the clinical importance of these effects remains uncertain.1,2,19... 

Albuterol is the preferred bronchodilator for treatment of acute exacerbations because of its rapid onset of action. Ipratropium can be added to allow for lower doses of albuterol, thus reducing dose-dependent adverse effects such as tachycardia and tremor. Delivery can be through metered-dose inhaler (MDI) and spacer or nebulizer. The nebulizer route is preferred in patients with severe dyspnea and/or cough that would limit delivery of medication through an MDI with spacer. If response is inadequate, theophylline can be considered however, clinical evidence supporting its use is lacking. 

Systemic toxicity of inhaled corticosteroids is minimal with low to moderate inhaled doses, but the risk of systemic effects increases with high doses. Local adverse effects include dose-dependent oropharyngeal candidiasis and dys-phonia, which can be reduced by the use of a spacer device. The ability of spacer devices to enhance lung delivery is inconsistent and should not be relied on. 

Newman, S.P., Clark, A.R., Talaee, N., and Clarke, S.W., Pressurized aerosol deposition in the human lung with and without an open spacer device. Thorax, 44 706-710 (1989). Newman, S.P., Clark, A.R., Talaee, N., and Clarke, S.W., Lung deposition of 5 mg Intal from a pressurized metered dose inhaler assessed by radiotracer technique, Int. J. Pharm., 74 203-208 (1991). 

Aerosolized medications are available as pressurized or breath-actuated metered-dose inhalers (MDIs), dry powder inhalers (DPIs), and nebulized or wet aerosols. Most inhaled medications currently used are available as metered-dose inhalers (Table 3). For the patient who has difficulty to coordinate activation of a MDI, a spacer improves delivery. Spacers reduce deposition of the drug in the... 

Spacer/Holding inhalation or tidal breathing face mask enables MDI to be used... 

Oral candidiasis is seen in some 5-10% of patients who use inhaled glucocorticoids, particularly when oral hygiene is poor, but is rarely symptomatic. The risk can be reduced by the use of a large-volume spacer (141,142). 

The systemic availability of an inhaled glucocorticoid represents the additive and complex combination of pulmonary and gastrointestinal drug absorption. Absorption is influenced by many factors, including delivery device, the use of a spacer, the particle size of the inhaled drug, and the absorption and metabolism of the swallowed drug (1). 

The local adverse effects of inhaled glucocorticoids have been studied in a prospective, cross-sectional, cohort study in 639 asthmatic children using beclomethasone (721 micrograms/day) or budesonide (835 micrograms/ day) for at least one month (28). The local adverse effects included cough (40%), thirst (22%), hoarseness (14%), dysphonia (11%), oral candidiasis (11%), perioral dermatitis (2.9%), and tongue hypertrophy (0.1%). A spacer doubled the incidence of coughing. 

The efficacy and safety of fluticasone 750 micrograms/ day and beclomethasone 1500 micrograms/day delivered by a spacer device have been compared in 30 asthmatic children in a 12-week, randomized, double-blind, crossover study (118). All of the children had persistent asthma requiring 1000-2000 micrograms/day of inhaled glucocorticoids before the trial. There was no significant... 

Thorsson L, Edsbacker S. Lung deposition of budesonide from a pressurized metered-dose inhaler attached to a spacer. Eur Respir J 1998 12(6) 1340-5. 

Goldberg S, Einot T, Algur N, Schwartz S, Greenberg AC, Picard E, Virgihs D, Kerem E. Adrenal suppression in asthmatic children receiving low-dose inhaled budesonide comparison between dry powder inhaler and pressurized metered-dose inhaler attached to a spacer. Ann Allergy Asthma Immunol 2002 89(6) 566-71. 

The active inhaler made by Nektar Therapeutics (formerly Inhale Therapeutic Systems, United States), called Pulmonary Delivery System (PDS), mechanically compresses a fixed volume of air required for delivery and dispersion of a premetered dry-powder unit dose by a spring-loaded pump (Fig. 8.10). Generation of the respirable aerosol cloud thus is independent of the inspiration effort exerted by the patient. The aerosol is generated in a transparent holding chamber that acts as a spacer from which the patient inhales the standing cloud of particles (Patton 1997). The PDS device is actually close to market for inhaled delivery of insulin under the trade name Exubera. 

G. Dickens, D. Wermeling, C. Matheney, W. John, W. Abramowitz, S. Sista, T. Foster, and C. S., Flunisolide administered via metered dose inhaler with and without spacer and following oral administration, J. Allergy Clin. Immunol. 103, S135 (1999) 703 S132 (1999). 

O. Selroos, and M. Halme, Effect of a volumatic spacer and mouth rinsing on systemic absorption of inhaled corticosteroids from a metered dose inhaler and dry powder inhaler, Thorax 46 891 (1991). 

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